Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward



  • Prescription drug price updates that may affect Medicare Set Asides - update July 24, 2018

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    | May 15, 2019
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    WCMSA, AWP, Medicare Set-Aside, Medicare Insights
    To ensure the most accurate Workers’ Compensation Medicare Set-Aside (WCMSA) arrangement, we monitor RED BOOK® Average Wholesale Price (AWP) of the most common medications present in WCMSAs. This practice assists in identifying price changes, which may either positively affect settlement and provide savings, or increases that could hinder the settlement process and increase claims costs. In the month of June, there were price changes for morphine sulfate tablets – both immediate release and extended release—brands MS Contin and Dilaudid, opioids commonly used for chronic pain. Products with price increases are relatively insignificant at less than 10 percent. However, the decreases are greater than 50 percent, and could provide savings on cases where these medications are prescribed.


  • Updated Medicare Secondary Payer recovery portal user guide released

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    | May 15, 2019
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    CMS, Medicare Secondary Payer, Medicare Insights
    On July 2, 2018, the Centers for Medicare and Medicaid Services (CMS) released limited changes in version 4.2 of its Medicare Secondary Payer Recovery Portal (MSPRP) User Guide. This new information aims to provide electronically current and consistent conditional payment information. In addition, the portal information is designed to help settling parties involving Medicare beneficiaries expedite the process.


  • Prescription drug updates may positively affect Medicare Set Aside - update May 2018

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    | May 15, 2019
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    Medicare Insights, WCRC
    Capitol Bridge, LLC assumed the reigns as the new Workers’ Compensation Review Contractor (WCRC) on 3/19/2018. Immediately following the transition to Capitol Bridge, it was noted that they have a different methodology for pricing. This has caused a slight increase in counter low/high determinations as the industry adjusts to the pricing methodology changes.


  • New WCRC, Capitol Bridge: Changes and trends

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    | May 15, 2019
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    WCRC, Medicare Insights
    Capitol Bridge, LLC assumed the reigns as the new Workers’ Compensation Review Contractor (WCRC) on 3/19/2018. Immediately following the transition to Capitol Bridge, it was noted that they have a different methodology for pricing. This has caused a slight increase in counter low/high determinations as the industry adjusts to the pricing methodology changes.


  • Don’t rely on an MSP Conditional Payment notice when executing a settlement agreement and general release

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    | May 15, 2019
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    Medicare Insights, Conditional Payment
    In a recent decision on 3/13/2018, Mayo v. NYU Langone Medical Center, the courts voided a settlement on the grounds of a mutual mistake because both the plaintiff and defense relied upon a conditional payment notice rather than a conditional payment demand or initial determination.


  • Frank Fairchok Rejoins Optum Settlement Solutions

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    | May 15, 2019
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    Medicare Insights
    Optum is pleased to announce that Frank Fairchok has recently rejoined the settlement solutions team as vice president of Medicare compliance reporting and development.


  • CMS Releases Update to WCMSA Reference Guide

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    | May 15, 2019
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    Medicare Insights, WCMSA
    The Centers for Medicare and Medicaid Services (CMS) released an update to their Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (version 2.7) with two changes.



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